Choosing rad onc over heme onc

[inomed]

Would it be a mistake to choose rad onc over IM to heme onc for the following reasons?

I’m currently a med student debating between the two paths and leaning towards rad onc. I’ve always loved the science of oncology and especially immunotherapy and drug dev. However as a practice, heme onc seems very emotionally taxing managing end of life discussion, late stage disease, chemo toxicities, and serving as primary. Heme onc also seems tougher to stay up to date with. I feel like rad onc has less of this, but maybe I'm mistaken?

Meanwhile rad onc still lets you be involved in oncology care but in a different way and generally in earlier stage of disease. I like engineering and physics principles (not so much anatomy), so I like the field too. I’d have to give up being the one to prescribe innovative therapeutics and in stead focus on scans all day which is the one drawback. I understand the limitations of a rad onc career but it doesn’t seem as bad as folks make it out to be. Are these reasons to go into rad onc over heme onc valid?

I’m also not the biggest gen IM fan, and IM residency is hard. If I go through an IM residency, it does open more doors to other science heavy fields like rheum and allergy too which could also be decent options though pay would be less than both rad onc and heme onc.

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[HemeOncHopeful19]

It would not be a mistake to do Rad Onc over Heme Onc IMO.

I do think it would be a mistake to think those downsides of Heme Onc somehow don’t apply to Rad Onc.

The biggest pro to Rad Onc over Heme Onc is virtually nonexistent call burden. The biggest con is less geographic flexibility - this will probably still be a thing by the time you would finish but harder to predict.

IM residency is not hard.

Surgery residency is hard.

 

[inomed]

What is more emotionally taxing between rad onc and general IM as hospital medicine can have lots of end of life care as well? Is it true that rad onc sees cases with better outcomes and is less emotionally difficult or not really? This is honestly currently the biggest differentiator for me. As a science, I like heme onc better. But the day to day job of rad onc seems more sustainable long term.

 

[bobsmith]

Well there's probably significant selection bias here when you go to a forum of oncologists and ask "isn't your field too emotionally taxing?"

I think for those of us that are oncologists, we sometimes take it for granted that we all had to be OK with (or learn to be cope with or find it fulfilling in some way) to be in this field that can be emotionally difficult at times. The trainees that did oncology rotations and very much did not like it would not have chosen this field and therefore won't be answering your question on this forum.

That being said - have you worked in a heme/onc clinic at any point? And if so, what was your experience like?

Just in looking at my clinic schedule from yesterday - I had 8 pts that were non-malignant hematology (thrombocytopenia, anemia, VTE, etc), 2 pts with masses that are being worked up, 4 who are either on adjuvant / surveillance and 5 on active "palliative intent" treatment - 3 are doing well for now and 2 are struggling in some way.

Of course, some weeks are like gutonc's clinic that he mentioned last week that are just really brutal, but it's not like we see 20 emotionally wrecking cases every day for an entire career (at least as a community heme/onc doctor, anyway)

I can't speak to how emotionally taxing it is to be a radiation oncologist as I have never done a rotation in it. I like the rad onc doctors I work with and I have to imagine that when they treat patients with curative intent and follow them afterwards and find a recurrence, it still sucks for them emotionally. I personally find it empowering to be able to tell a patient "here's what we're going to do about it" after a recurrence happens as opposed to "OK I'm just going to refer you to med onc now," but that probably just speaks to my personality / why I chose oncology or - maybe just how I've learned to cope with things!

 

[gutonc]

Your questions have been asked and answered more thoroughly than anyone could hope for. At a certain point, you need to make a decision. Nobody here can give you anything but their own experiences. But those are not going to be your experience.

The most sustainable job is the one you enjoy. Vascular surgery would not be sustainable for me, but there are plenty of very happy and successful vascular surgeons out there who love what they do. They would probably crash and burn in hem/onc. Horses for courses and all that.

 

[solidonc2020]

You've gotten good answers here already, but wanted to give my two cents as I was in a simlar place as a med student. My first oncology clinical exposure was with a rad onc rotation which I loved, primarily due to being involved with an excellent weekly tumor board and enjoying the patient population.

Probably the easiest way to make this decision is whether you enjoy your MS3 internal medicine rotation or not, which I did. For someone who wants to take care of cancer patients, that's an easy enough qualifier between these two IMO.

Like IM? Do IM --> heme/onc. Hate rounding and thinking through medical complexities, but don't mind physics? Do rad/onc.

 

[ONC2023]

Why not the best of all worlds: diagnostic radiology? But that’s just me pining for the ability to stay home and read scans without dealing with people.

 

[gutonc]

Why not the best of all worlds: diagnostic radiology? But that’s just me pining for the ability to stay home and read scans without dealing with people.

Do NOT start with this guy...please.

 

[Plutarch02]

The job market is very terrible in rad onc, 1-2 years ago I was talking to rad residents who were worried about not getting jobs at graduation. I honestly would steer clear of the field for that reason. That said by the time you get to the job market it can certainly change for the better.

 

[MifflinDunder]

Rad onc will have a better lifestyle since you’re not the primary oncologist, don’t have to take call or do clinic all week. I rotated in both as a med student and still think about why I didn’t pick it.

 

[HemeOncHopeful19]

I’m just waiting for the Rad Onc forum to discover this thread and come in guns ablazing about how terrible they have it because they can’t make 7 figures in 2010 dollars anymore

 

[inomed]

The job market is very terrible in rad onc, 1-2 years ago I was talking to rad residents who were worried about not getting jobs at graduation. I honestly would steer clear of the field for that reason. That said by the time you get to the job market it can certainly change for the better.

All the residents at my program and others I've talked to have gotten decent job offers. Sure not all were 500k+ in NYC, but still very solid offers I'd be happy with.

 

[inomed]

Rad onc will have a better lifestyle since you’re not the primary oncologist, don’t have to take call or do clinic all week. I rotated in both as a med student and still think about why I didn’t pick it.

Would you rather do rad onc than heme onc now?

 

[MifflinDunder]

Would you rather do rad onc than heme onc now?

Yes. Being a primary oncologist feels like I'm doing primary care, and that's with me punting all the HTN/HLD/DM2/screening stuff to PCPs.

 

[osprey099]

Money and job market will change. What won't change is your personality. I chose med onc (IM) because I feel privileged to be that one person who can help a metastatic cancer patient live longer and live better. I enjoy my work and honestly, would gladly take a 50% pay cut if it meant all of my patients had great outcomes. I give my cell phone number to some of my patients who need more hand-holding. I wake up every morning and look forward to working. The vast majority of my patients put me on a pedestal and my staff caters to all my needs and I do very minimal non-oncological work. I also enjoy talking with drug reps and MSLs, having them go on my waitlist to take me to fancy dinners and such.

I'm still early on in my career and my attitude about certain things may change but this is the way I see it now.

 

[Ubba]

Rad Onc is the easy choice if you are extremely geographically flexible (e.g., as ok living in Oklahoma as in Montana, Florida, or Maine). You swoop in to deal with a particular problem, plan your radiation fields while drinking coffee, chat with patients for a few minutes about how radiation zaps cancer cells, complete the course, prescribe some meds for rashes and nausea here and there, and boom - paid.

The money is great. Are they making 3 mill/year like they were in the early 2000s? No, but Heme/Onc gets substantially worse remuneration/hr as a field. When's the last time a Rad Onc got a call at 8:30 pm about a critical Hgb of 6.9 g/dL and had to wrestle with the Q of whether to advise the pt to go to the ER, balancing pt QOL with medicolegal liability? (Hint: I err toward prioritizing the latter every time.)

Medical Onc is a good field, but once you enter, it is your life practically 24/7. If you don't want that, do Rad Onc. It's not going anywhere. We are not referring any less now than when I started training almost 3 years ago. I don't regret doing Med Onc specifically because geographic preferences are important to me, but that really is the major factor.

 

[inomed]

Rad Onc is the easy choice if you are extremely geographically flexible (e.g., as ok living in Oklahoma as in Montana, Florida, or Maine). You swoop in to deal with a particular problem, plan your radiation fields while drinking coffee, chat with patients for a few minutes about how radiation zaps cancer cells, complete the course, prescribe some meds for rashes and nausea here and there, and boom - paid.

The money is great. Are they making 3 mill/year like they were in the early 2000s? No, but Heme/Onc gets substantially worse remuneration/hr as a field. When's the last time a Rad Onc got a call at 8:30 pm about a critical Hgb of 6.9 g/dL and had to wrestle with the Q of whether to advise the pt to go to the ER, balancing pt QOL with medicolegal liability? (Hint: I err toward prioritizing the latter every time.)

Medical Onc is a good field, but once you enter, it is your life practically 24/7. If you don't want that, do Rad Onc. It's not going anywhere. We are not referring any less now than when I started training almost 3 years ago. I don't regret doing Med Onc specifically because geographic preferences are important to me, but that really is the major factor.

I don’t need to be in a specific city but I do want to me in at least a tier 2-3 metro like a Charlotte, Cincinnati, Tampa, etc.

 

[evilbooyaa]

I’m just waiting for the Rad Onc forum to discover this thread and come in guns ablazing about how terrible they have it because they can’t make 7 figures in 2010 dollars anymore

No need to clutter your guys's forum when we've already had a 2 page thread on it in our own:

I

Thread 'Rad onc is the only specialty in medicine I could see myself doing, what should I do?'

Jan 27, 2025

Is the job market so bad, that I should avoid rad onc as I am only competitive for a mid-tier place currently? I cannot see myself practicing any other field of medicine. What is the worst case scenario? An 8-5 job paying 300k? That's still better than being a hospitalist or PCP in my opinion.

• inomed
• Replies: 91
• Forum: Radiation Oncology

• 

 

[gutonc]

No need to clutter your guys's forum when we've already had a 2 page thread on it in our own:

I

Thread 'Rad onc is the only specialty in medicine I could see myself doing, what should I do?'

Jan 27, 2025

Is the job market so bad, that I should avoid rad onc as I am only competitive for a mid-tier place currently? I cannot see myself practicing any other field of medicine. What is the worst case scenario? An 8-5 job paying 300k? That's still better than being a hospitalist or PCP in my opinion.

• inomed
• Replies: 91
• Forum: Radiation Oncology

• 

I kind of assumed the OP had cross-posted but forgot to look.

Locking.